Health Insurance for a thru hike

[Ktaadn]

You just never know what will happen. Catastrophic insurance at a minimum is the only intelligent choice.

I think catastrophic insurance should actually be the maximum and only intelligent choice. That is the reason that insurance was created in the first place, to save you from catastrophic loss. I mean that for all insurance, not just health.

[Offshore]

And the health care exchanges are a joke. I pay $1900 a month for coverage for my family. This is traditional Blue Cross coverage that includes a decent provider network. It is not a cut-rate plan offered by healthcare.gov. So that is ~$25k per year, every year. No way we use that much.


Sent from my iPhone using Tapatalk

Then why do you carry insurance? Why not self-insure and negotiate as you go along as you seem to be advocating to the OP?

[magneto]

I live in Massachusetts and I am required by law to carry medical insurance.

With the kind of money I am paying, it may be worth it for me to buy a very minimal government insurance policy and then self insure the rest of the way. I am considering that.


Sent from my iPhone using Tapatalk

[Offshore]

I live in Massachusetts and I am required by law to carry medical insurance.

With the kind of money I am paying, it may be worth it for me to buy a very minimal government insurance policy and then self insure the rest of the way. I am considering that.

Sent from my iPhone using Tapatalk

That would seem to make sense. Go for a high deductible plan with a healthcare savings account for some added tax benefits.

[magneto]

My PCP doesn't take insurance as primary payment. He charges a flat fee for the year and that gives me access to him directly, via his cell phone. We settle up for services each visit, but due to the flat fee structure, payment is not always due for each visit.

He will take my insurance when payment is due but he says it is increasingly more expensive each year to do so. I've seen the regs as I believe him.

Before he switched to this style of practice, he had whole staff positions dedicated to processing insurance claims. Now all that is gone and he has fewer patients, resulting in better service.

This model of medicine makes at lot more sense to me and I spend a lot less time dealing with doctors.


Sent from my iPhone using Tapatalk

[magneto]

That would seem to make sense. Go for a high deductible plan with a healthcare savings account for some added tax benefits.

Unfortunately, the ACA is making that HSAs illegal. You have to choose the crappiest plan available to avoid the income tax surcharge - then pay the rest out of pocket. It will be after tax dollars but freedom isn't free. So if you want out of Caesar's system, you have to pay him for the privilege.

Now, let's return to hiking...


Sent from my iPhone using Tapatalk

[Offshore]

Unfortunately, the ACA is making that HSAs illegal.

Not true, most bronze level ACA plans let you have an HSA.

But getting back to the thrus out there -

Remember that under the Affordable Care Act, if a parent's plan covers children, they can be added to or kept on a parent's health insurance policy until they turn 26 years old. Children can join or remain on a parent's plan even if they are married, not living with their parent, attending school, not financially dependent on their parents or eligible to enroll in their own employer’s plan. These rules apply to both job-based plans and individual plans bought inside or outside the Marketplace. So if you are under 26, stay on a parent's plan if possible.

As to the original poster who is 32 and taking a sabbatical and will be back to work, I'd ask your employer about options for health insurance continuation. An idea would be to offer to pay both the employer and employee portions of the premium (sort of like COBRA works if you leave a job). You'll at least get the benefit of the group policy rate.

[BuckeyeBill]

I have been reading this thread from the beginning and thought I would chime in on a related subject. My father's doctor told my dad that he had just lust attended a conference sponsored by an insurance company. They told him (the doctor) that if they were spending more than 10 (ten) minutes with a patient they were losing money.

I have seen my own doctor come in the room listen to my stomach (Crohn's disease) and ask me how I feel. I tell him fine.Total time 5 minutes and he checks a medium visit on the patient billing sheet. My pulmonary doctor does the same thing. At times I feel cheated but at least I am not fighting a flare in my gut and I can breath OK.

[Just Bill]

I have been reading this thread from the beginning and thought I would chime in on a related subject. My father's doctor told my dad that he had just lust attended a conference sponsored by an insurance company. They told him (the doctor) that if they were spending more than 10 (ten) minutes with a patient they were losing money.

I have seen my own doctor come in the room listen to my stomach (Crohn's disease) and ask me how I feel. I tell him fine.Total time 5 minutes and he checks a medium visit on the patient billing sheet. My pulmonary doctor does the same thing. At times I feel cheated but at least I am not fighting a flare in my gut and I can breath OK.

My mother (A nurse) left the bedside long ago for insurance coding, case management, and physician group consulting. It is quite sad really. As far as I understand- the medium visit is an internal metric used by a physician consulting group- the insurance company doesn't pay by the hour, only by the visit- but the bean counters the doctor's group pays to bean count do track the doc's production that way. Many of those little remarks on the paperwork are for internal billing methods.

The Doc is losing money if he is there longer than 10 minutes per hour because 20 minutes of that hour are wasted in office overhead simply to bill an amount they can't collect. The doc's groups and consultants have added "creative billing" into the mix and further messed up things, putting the insurance company on guard or forcing them to reduce payments. You can bill a $90 office visit, or break it down into each band-aide and asprin and collect $95 for a month. Eventually the payer figures it out and pays you $90 again. Or more often- they are more creative than you and you get $80. Then the doc group cries about not getting paid and hires a new consulting firm.

Hopefully, much like car insurance, mandatory insurance is the first step in cleaning up this mess for us all.
No other form of insurance I have dealt with is as convoluted or spends so much money insuring itself from itself. There is not an entire industry of workers out there disputing, misfiling, consulting, or outright stealing for Auto, Home, or life insurance. Have you ever heard of a company having a plan administrator for their vehicle insurance? My current company had 55 vehicles at one point, which required virtually no overhead. But we had a full time plan admin, and no less than three consulting firms to review claims and ensure that our HSA was not being abused by the insurance company. So now the employer needs their own consultants to outwit the doctor's and insurance company consultants.

Malpractice insurance is a significant cost for docs, but no other industry has such a complicated and expensive system of billing for services, and as a result this overhead is passed on. Everyone knows the negotiated rate is say $90, why the doc bills $180 to the insurance company to review and reduces is beyond me. If you take XYZ insurance, you are aware of what XYZ insurance pays regarding it's negotiated rate. Why you would intentionally add another 30-45 days to your receivables turn-around when you know you can only bill $90 is silly. Add carrying the costs incurred for the service for 90 days to add insult to injury. Receivable turn-around puts construction companies out of business, I have no sympathy for the Doc's in this regard.

A scary thought, mostly off topic- physical insurance companies (like home, auto, property) are currently paying roughly $1.16 in claims for ever $1.00 they collect. (Lowest number I heard) Generally these companies are not exempted from "Act of God" coverage. As in, you can't deny a flood insurance claim by declaring the flood an act of god. HOWEVER, in an interesting turn of events for global warming, it may be possible to deny coverage due to "acts of man" beyond the data available to the insurer. The insurance companies are currently working to declare events that exceed available 100/500 year data as the result of human induced global warming, and therefore not covered. The insurance companies are not set up to cover 100 year events every five years, and that system will not tolerate it for much longer. So global warming advocates suddenly have a powerful interest mobilizing...

Just another exciting prospect on the horizon.

[magneto]

Insurance companies can pay out more on claims than they collect in premiums and still make money because they invest the premium dollars they collect and earn a rate of return.


Sent from my iPhone using Tapatalk

[Alligator]

I am going to ask again for people to dial in the conversation to address the OP's question.

For instance, how might changing residency affect her insurance? How do states determine this and are there common rules? If she relocates, it may be beneficial to maintain one or another plan until she makes a transition. Is there some kind of grace period to do this, because rates between say SD and MA may be very different.

[Just Bill]

Yar- no more from me, rounded the bend somewhere in there into crazy town.

[sympathetic joy]

Check out World Nomads:

http://www.worldnomads.com/


They are geared for international travel but domestic travel health insurance is possible. A 6 month policy is $335. They do have a rule for domestic travel that it only covers you if you're more than 100 miles from 'your' home.

http://www.worldnomads.com/travel-in...px?Country=USA

You should call or write them with any questions. I used them for a 1 month policy when I was traveling overseas. Luckily I didn't have to use the policy. Hiking is one of the covered activities for USA residents under their standard plan.

http://www.worldnomads.com/travel-in...insurance.aspx

I"m not one to quote myself - but with all the side chatter I didn't want this to get lost. I still think this has the most potential for the OP.

[no-name]

In my experience, there is what the health provider charges and the negotiated rate they will get from the insurance company.
I am always amazed at the difference between the amount that is billed and then what the heath care provider actually gets paid (bcause of insurance). Alot of people have financial trouble because they are charged the full amount
I see the benefit of having a heath insuance card as a way to get the lower negotiated rate.
I wonder what the cheapest card I can get at 49, just to give me "negotiated" rates?

[Aussie Legs]

I plan to take out international travel insurance (I'm from Australia) - I'm hoping that will be enough to cover any health issues/doctor's trips that I might encounter along the way... I'm assuming I'd have to pay upfront and then claim it back later. All this discussion about health cover is a huge eye opener - Australia's health system must be pretty good... anyone can enter ED and become a "public patient", meaning they don't pay for any treatment they receive while there. I really should get around to getting some health care cover back here though, in case I have to have physio or something on my return (although this could be covered by travel insurance if it's a result of an accident that occurs while overseas). Any other hikers coming internationally?

[2015 Lady Thru-Hiker]

I"m not one to quote myself - but with all the side chatter I didn't want this to get lost. I still think this has the most potential for the OP.

Don't know about the OP but I will be in pretty much the same situation and plan to look into the domestic insurance option. If it is only around 300-500 dollars I'll probably do it. Falling and breaking my wrist while hiking in NY cost me over 500 with insurance.

[Traveler]

OP here-I have a PPO network plan with a 2500 deductible and a heath savings account. However, my organization is switching to a new plan in coming months so I am not sure what the features of the new plan. I know I originally used the term sabbatical, but I am actually planning on resigning from my organization and relocating after my thru-hike. I considered the Cobra option and can see how much that will cost when the time comes, but I have found in the past that is usually higher then some higher deductible plans I could choose. I am rather healthy but do take a daily medication. I also only pursue medical care for preventative care or as a last resort.

Keep in mind COBRA plans will require you to pay the full cost of your insurance that is incurred by your employer. For example, if you pay 150 a month you will pay that, plus the balance of cost your employer subsidizes you. On that initial cost of 150 you may find a 400 dollar monthly bill. Its not a lot, but if its not considered it may come as a surprise.

[Offshore]

Keep in mind COBRA plans will require you to pay the full cost of your insurance that is incurred by your employer.

+1 - and you may find that the employer share for which you are now responsible is 2x - 3x your former share of the premium. Terminating employment may allow the OP to qualify for a special enrollment period under the ACA exchange in their state, so its worth checking out the cost of COBRA vs. the state exchanges.

[fiddlehead]

It's an old argument on whiteblaze.
There are those who feel you need it, and others who think it's a waste of money.
I'm in the latter group.
Always have been.
But, now that i have a son, I went out and bought some.
Breaks my heart every time the bill comes.
Still haven't used it.

I did 3 or 4 thru-hikes on the money I saved by not paying before.

Why do you think Warren Buffet is one of the richest guys in the world.
Where do you think he has most of his assets? (it ain't coke)

[Offshore]

But, now that i have a son, I went out and bought some.
Breaks my heart every time the bill comes.
Still haven't used it.)

I can appreciate your frustration. I'm come to terms that part of what you buy with insurance is peace of mind - and only you can judge what that's worth to you. I never complain about not using my health insurance - that means things are going well.